The shaft is primarily absent, with only a small portion of the proximal end present, due to amputation. The distal extent of the bone is diminished and has an irregular pitted surface. There are three anterior projections of bone, one below the coronoid process and two distal to the radial notch on the lateral border of the shaft.
When compared to the right side the shoulder, arm and forearm shows considerable atrophy, most likely from disuse.
The level of amputation on the ulna is at that of the radius exactly. The individual may have lost their arm in an accident, rather than it being surgically removed.
First lumbar vertebra
There are irregular indentations on the inferior and superior surfaces of the body in the centre of the posterior half. The lesions retain the original cortical bone for most of the floor. The superior indentation measures at its greatest 18.3mm mediolateral x 9.8mm anteroposterior x 4mm deep. There is a small nodule of new compact bone on the left lateral border of the lesion, minimal trabecular exposure and a small area of irregular coarse pitting centrally in the base. The inferior indentation is crescent shaped and has more trabecular exposure than the superior lesion and measures at its greatest 16.9mm mediolateral x 5mm anteroposterior x 3.3mm deep.
Degenerative joint disease-Schmorl’s node
There is a well healed transverse fracture at midshaft with complete posteromedial displacement of the distal shaft. The medial half of the proximal end of the shaft has remodelled compact bone. A distal extension of remodelled compact bone that surrounds the shafts creates a bridge between the fractured halves, except on the distolateral half of the posterior surface where the space between the two halves is filled with irregular spicules of new compact bone, having a minimal amount of pitting. There is slight pitting on the anterior surface superior to the fracture.
There is slight osteophytosis of the femoral head. The head also has surface contour changes superior to the fovea, including a depression measuring 5mm mediolateral x 9.6mm anteroposterior. Osteophytic extensions of the articular surface of the head bridge onto the neck on both superoanterior and superolateral aspects.
The distal articulation has extensive osteophytosis with the patellar surface having contour change, surface erosion, new compact bone formation and pitting. The lateral condyle has a large irregular osteophyte interrupting the medial margin and the articular surface has new compact bone and surface pitting. The medial distal portion of the medial condyle has extensive eburnation and grooving, with a nodule of new compact bone anterior to this area and a zone of pitting and contour changes within the medial half of the eburnated area.
The osteoarthritic changes of the distal femur and lack of atrophy of the bone and muscle attachments suggests that the individual had been using their leg for some time after fracturing the shaft.
Degenerative joint disease-osteoarthritis
Degenerative joint disease-osteophytosis
Distal to midshaft along the lateral side of the linea aspera at the attachment for quadriceps and biceps femoris is a large exostosis of bone measuring 45mm proximodistal x 19.5mm anteroposterior x 8.2mm mediolateral at its greatest. There is continuity from the cortical bone to the exostosis.
The x-ray confirms that this is an osteochondroma.
There is a well-healed fracture at midshaft. The distal portion is displaced anteriorly and proximally, and is angled medially. There is little evidence of a callus remaining.